Approval questions

Ok I am looking into getting a revision done. Right now I am sitting at a BMI of 29.6, on the verge of obesity. I am about 45 lbs from my goal weight. So..... I contacted a place for revisions and the doc has told me that insurance really fights it to be approved. That you have to have an endoscopy to prove that your throat or stomach is messed up and they can go in and repair and revision for that. But I have hella good insurance. It is with Blue Cross/Blue Shield for federal employees.

So......how hard is it to get approved? Should I even bother doing the endoscopy? Is there anything I can do to up my chances at getting approval? Help!

Deb

Do you have any co-morbidities?...sleep apnea, high blood pressure, etc  I was just approved today for my revision (BCBS fed), but my BMI is higher with no Co morbidities.

You have to qualify first for WLS...do you qualify?

Edited to add;  They did approve the new procedure (DS) but did not approve the revision part..I have to pay the surgeon for the removal of my band.  SO it can get tricky, and you might have to pay a portion.

To be honest I am not sure. The dr. says that no matter if I have 1 or a million co morbidities that it won't matter bc insurance companies don't care? That sounds kind of strange to me.  I do have intense back pain and have had to have medication and did a chiro visit, about to go to the dr for that again here shortly to have a specialist check it. I have the heartburn and incontinence stuff. Nothing huge but for initial wls, I didn't have anything either. I am less than 1 away from being considered obese on the bmi which is depressing as all hell. So I am wondering how insurance would look at it? I have called them and they said no problem as long as I qualify for wls bc they cant even find revision in the system. So its like everyone is clueless.

I just made my apt for my endo for this friday. I want my body back :-(

Just looked up the plan details online and it said that under 35 i have to have co morbidities for wls. So would the chiro/back issues and heartburn/incontinence count? I have medical proof of getting meds and chiro for the back but nothing really for the rest. Maybe thats why he wants to endo to just add more fuel to their fire so to speak? Should I do more chiro visits just to help to get approved?

Hi!  Just curious.....I have the same insurance that you do.  my BMI is 56.  I had lapband in 2007 and am looking for a revision.  If you don't mind sharing was there any way around them paying for your revision?  If not how much will it cost to have the band removed?  I hate this lapband!

Thank You
Melissa

Your BMI is so low..I don't think it will matter much personally.  But talk to your doctor and maybe ask a few other drevision doctors what their office has experienced.

good luck.

And yes often times the doctor will try to do more tests etc to build a case. But again even then your BMI is too low

hmmmm maybe I am wasting my time then . Bummer.

Hi Strawberry 28,
I just made an appointment with Dr. Elariny.  I am interested in revising to the DS.  If you don't mind answering a few question, could you please let me know :  
          your opinion of the doctor and the office personel  ( the receptionist was very helpful)
          how long it took to get an appointment
          how long it took you to get approved by your insusrance
          did you have to pay any fees up front and how much

I was originally going for the distal revision but with the amount of weight I need to lose, I think the DS would be better.
Thanks so much for your answers.  I wish you well with your up coming surgery.
Marianna